By Wesley Gallagher
The American opioid epidemic is at crisis levels, and it seems like the government and other organizations are finally taking steps to address the crisis. In order to do this effectively, we must understand the root of it — from the individual problem of addiction to the history and reasons behind the prevalence of drug use in America.
America’s drug history is a long and complicated one, and the history of opioids and their role in the increase of drug abuse and overdose deaths offer great insight into why we’re in our current state of crisis.
How Did We Get Here?
The flourishing of opioid use in America over the last couple of centuries has been fueled by several factors.
Opium first made its way to the United States in 1775.1 In the early 1800s, morphine was first synthesized from the opium plant, and by the Civil War, hundreds of thousands of soldiers were being treated with the drug. By the end of the century, Bayer was selling heroin for pain relief and cough suppression, and by 1910, people were crushing opioid pills and inhaling them for pleasure.2
In 1914, Congress passed a bill making opioids available by prescription only. While the original intent was to reduce recreational use, the Federal Bureau of Narcotics took it as a mandate to stop prescribing opioids altogether. From the 1920s to the 1950s, doctors rarely prescribed opioids outside of postoperative pain, acute pain and in the care of the dying. The prevailing thought was that opioids were highly addictive and should only be used as a last resort.
In the 1970s, doctors began researching pain and recommending opioids for long-term use in cancer patients. In 1980, a letter was released stating that, despite widespread use of narcotics in hospitals, the development of addiction was rare. This letter was not a peer-reviewed study and only studied patients in hospitals, yet it was treated as gospel over the next several years as opioid prescribing skyrocketed.2
By 1990, opioid treatment in cancer patients was common, and researchers and pain societies began advocating for the use of opioids in other chronic pain management, claiming little risk for addiction. Alongside these recommendations came pharmaceutical companies who exaggerated benefits while downplaying risks of opioid use.
In 1996, a new opioid came to market, and Purdue Pharma claimed it lasted longer than other pills and had less risk for addiction. They spent $207 million on marketing for this new drug, Oxycontin. Not surprisingly, opioid prescriptions soared. Morphine prescriptions also increased by 73 percent between 1997 and 2002, and oxycodone prescriptions increased by 402 percent.2
Throughout the 1990s, several studies came out showing high risk for addiction in long-term opioid users, but pharmaceutical companies ignored them. By 2001, at the behest of pain societies that were often backed by pharmaceutical companies, pain was added as a fifth vital sign for doctors to examine in their patients.
By the mid-2000s, teens were commonly stealing opioids from their parents’ medicine cabinets, and pain clinics and pill mills began popping up across the country. In Florida, where nine of the top 10 Oxycontin prescribing counties in the US were located, prescription drug overdoses increased 61 percent each year from 2003 to 2009.2
Efforts by the DEA to crack down on opioid diversion and overprescribing were often criticized and thwarted, while pharmaceutical companies settled lawsuits out of court and avoided bad press or evaded consequences altogether. Only in recent years have efforts been stepped up by the DEA and DOJ to punish companies and individuals involved in false marketing and illegal distribution and to stem the tide of overprescribing in our nation’s doctors’ offices.2
Opioids were involved in 63 percent of drug overdoses in 2015, and drug overdose deaths continue to rise. Seventy-five percent of heroin users say they used prescription opioids before switching to heroin.2 Despite widespread knowledge of opioid prescriptions leading to abuse — and years of government agencies, states and other organizations trying to curb the epidemic — we are still a country in crisis.
Why Do People Start Taking Drugs?
Obviously, a large percentage of the people who are addicted to opioids didn’t start out seeking to abuse them. For many addicts, the road to addiction began in the doctor’s office. For others, however — and for individuals who use other recreational drugs — the reasons for starting are varied.
The organization Rise Together surveyed 1,875 students in middle and high school and found that 35 percent of them had already tried drugs and alcohol by the age of 18. For first-time users, curiosity was the main reason they decided to try substances. But for the students who reported that they used substances consistently, the motivating factors were experiencing stress and challenges with their self-esteem.3
While these initial reasons aren’t necessarily predictors of future addiction, they don’t immediately disappear after teenage drug use and can fuel continued use. Drugs and alcohol don’t make stress and challenges disappear, and they don’t provide lasting social skills needed to be comfortable around others. But since drugs and alcohol seem to offer temporary solutions to these issues, many people continue using them.
With continued use, the problems that led to initial use can actually multiply. Relationships are damaged, finances are stressed and the ability to think clearly and make wise decisions is hindered by drug use. This, along with the chemical changes drugs produce in the brain, often begins the spiral into addiction.
Why It’s So Hard to Quit Taking Drugs
While the initial choice to use a substance is voluntary, repeated drug use leads to changes in the chemistry of the brain, altering the way people experience pleasure and hindering their ability to resist urges to continue use.4
Most drugs work by flooding the brain’s reward circuit with the pleasure-producing chemical dopamine. The reward circuit functions by controlling the body’s ability to feel pleasure and motivating a person to repeat behaviors that are needed to thrive, like eating and spending time with loved ones. Drugs cause an intensely pleasurable high by over-stimulating this reward circuit, thereby motivating a person to repeat drug use.4
As drug use continues, the brain adjusts to the excess dopamine by either making less of it or reducing the brain’s ability to absorb it, so the high achieved through drug use becomes less intense. As tolerance to these chemicals increases, more of the drug is needed to achieve the same amount of pleasure, and other activities that were once enjoyable can become less pleasurable as well. Eventually, a person may need to keep using drugs or alcohol just to feel normal.4
These brain changes also impact judgment and behavior in addicted individuals, causing them to seek out drugs despite possible negative or harmful consequences.5 Impaired judgment, combined with the need to chase the high as tolerance increases, is what makes quitting so hard. This doesn’t even take into account the negative life changes that come with repeated drug use, which can a create a situation that seems hopeless.
But that doesn’t have to be the end of the story.
There Is Hope
Fortunately, addiction is treatable. And with the help of comprehensive treatment that involves a combination of therapy and medical techniques, there is hope for addicted individuals.
On a broad scale, efforts to curb over-prescription and illegal diversion of opioids are being coupled with increased access to treatment for addicted individuals. Statistics from 2013 to 2015 show the first decrease in opioid prescriptions since 1996, as states enacted legislation to fund drug monitoring programs.2
We are a country in crisis, but we are also a country committed to ending the crisis. Armed with the right knowledge and necessary tools needed to combat it, there is hope.
1 “The History of the Opioid Epidemic.” Black Bear Rehab, Accessed October 15, 2017.
2 Elkins, Chris. “Searching for Relief: The Cause of America’s Opioid Epidemic.” Drugrehab.com, Accessed October 15, 2017.
3 “Youth Survey.” Rise Together, Accessed November 3, 2017.
4 “Understanding Drug Use and Addiction.” National Institute on Drug Abuse, Accessed October 15, 2017.
5 “Addiction as Disease.” Black Bear Lodge, September 25, 2015.
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